Prognosis of hepatocellular carcinoma with diabetes mellitus after hepatic resection

Abstract

We evaluated the effect of diabetes mellitus on the prognosis of hepatocellular carcinoma after an elective hepatic resection. Of the 342 patients who underwent a hepatic resection between April 1985 and March 1995, 87 (25.4%) were diabetic. Postoperative morbidity was more common among diabetics than among nondiabetics (36.0% vs. 22.5%, P ‫؍‬ .0239). The postoperative survival rate and the cancer-free survival rate were also better in patients without diabetes than in those with diabetes (P ‫؍‬ .0333, P ‫؍‬ .0149). The results of a multivariate analysis show diabetes mellitus to be an independent and prognostic indicator after a hepatic resection with hepatocellular carcinoma. According to the above findings, diabetes mellitus is thus considered to be a risk factor for prognosis after hepatic resection in patients with hepatocellular carcinoma. (HEPATOLOGY 1998;27:1567-1571.)The influence of diabetes mellitus on the outcome of elective surgical procedures remains controversial. [1][2][3][4] We previously reported that diabetic patients who underwent elective hepatic resections developed a higher incidence of postoperative morbidity, but not a shorter long-term survival. 5,6 Recently, Adami et al. 7 reported diabetes mellitus to be a risk factor for carcinogenesis in primary liver cancer based on a cohort study. However, little proof has been found regarding the effect of diabetes mellitus on the long-term outcome of patients with hepatcellular carcinoma after a hepatic resection. Therefore, the purpose of this study is to clarify the effect of diabetes mellitus on the long-term survival after a hepatic resection for hepatocellular carcinoma. PATIENTS AND METHODSBetween April 1985 and March 1995, 342 patients with hepatocellular carcinoma underwent a curative hepatic resection in the department of Surgery II, Kyushu University Hospital and affiliated hospitals. They ranged in age from 33 to 79 years (mean Ϯ SD, 59.7 Ϯ 8.3 years), and 275 (80.4%) were males. Liver cirrhosis was identified in 183 patients (53.5%). The methods of resection used included a trisegmentectomy in eight patients, a lobectomy in 84, a segmentectomy in 52, a subsegmentectomy in 64, and a partial hepatectomy consisting of less than a subsegmentectomy in 134. The follow-up period ranged from 34 to 4,036 days (median, 1,278 days; 25th percentile, 724 days; 75th percentile, 2,012 days).Of these patients, 87 (25.4%) were diagnosed with diabetes. The definition of diabetes mellitus was a fasting serum glucose above 7.8 mmol/L (140 mg/dL), abnormal results for a 75-g oral glucose tolerant test, or the need for insulin or an oral antihyperglycemic drug to control glucose levels. The preoperative control of diabetes mellitus was done either by diet alone or in combination with subcutaneous injections of insulin to maintain the fasting glucose below 8.3 mmol/L (150 mg/dL) and the 24-hour urinary glucose excretion below 10 g.The preoperative, intraoperative, and postoperative variables in the patients who underwent a hepatic resection with (HCC) were...

Diabetes Worsens the Surgical Outcomes in Cirrhotic Patients with Hepatocellular Carcinoma

“…In the present study, we identified the presence of diabetes as a factor significantly contributing to the recurrence of HCC and long- term overall survival after surgical treatment. The results are consistent with findings of Ikeda et al (Ikeda et al 1998). They evaluated 342 HCC patients who underwent a hepatic resection.…”

“…In our study, the incidence of DM was 30%, which was similar to findings of Toyoda et al with an incidence of 25.4% (Toyoda et al 2001). In a review of the related literature, rates of DM in HCC patients ranged 15% ~ 30% (Ikeda et al 1998;Huo et al 2004;Fattovich et al 2004;Komura et al 2007;Kawamura et al 2008). However, the incidence of diabetes was found to be higher among HCC patients who received hepatic resection.…”

“…In addition, the prevalence of type 2 DM is known to be higher in patients with chronic hepatitis and cirrhosis (Mehta et al 2000), in patients with HCC, and in HCC patients who received hepatic resection (Yanaga et al 1993;Toyoda et al 2001;Poon et al 2002;Huo et al 2004). Some studies suggested that DM is a significant risk factor for developing HCC (Yanaga et al 1993), and that it also adversely affects the long-term outcome of HCC treatment (Ikeda et al 1998). In our study, the incidence of DM was 30%, which was similar to findings of Toyoda et al with an incidence of 25.4% (Toyoda et al 2001).…”

“…The effect of diabetes on cancer recurrence in postoperative HCC patients remains controversial. Several studies documented that the coexistence of diabetes is a significant predictor of postoperative recur-rence in HCC patients (Ikeda et al 1998;Komura et al 2007; Kawamura et al 2008). In contrast, other studies reported that DM does not worsen the progression of HCC or its recurrence, nor does it significantly influence the long-term overall survival (Toyoda et al 2001;Poon et al 2002;Huo et al 2004).…”

Diabetes Mellitus Is Associated with Increased Mortality in Patients Receiving Curative Therapy for Hepatocellular Carcinoma

“…ies found an increased recurrence of HCC in patients with DM [17,30]. We could not analyze the HCC recurrence rates due to the limitation of the cancer registry, but LCS and LDS were both associated with DM.…”